Spontaneous Pneumopericardium and Pneumomediastinum in Twelve COVID-19 Patients

Juárez-Lloclla, Jorge Paul; León-Jiménez, Franco; Urquiaga-Calderón, Juan; Temoche-Nizama, Héctor; Bryce-Alberti, Mayte; Portmann-Baracco, Arianna; Bryce-Moncloa, Alfonso

doi:10.1016/j.arbres.2020.09.013

Cited by 34 publications

(49 citation statements)

References 14 publications

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“…On the contrary, after the second outbreak of the pandemic, since 1 October 2020 until the end of January 2021, of all 1648 patients admitted in the hospital, we observed the occurrence of these complications in 11 subjects, leading to a prevalence of 0.66%, similar to around 1% reported for hospitalized patients in the medical literature [ 3 , 11 , 12 , 13 ]. As in the other studies, the male gender prevailed (72.72%), and the supposed pathophysiological mechanisms were air leakage through the alveolar walls, damage by inflammation, and damage by the subsequent cytokine storm [ 1 , 2 , 5 , 14 ]. In our patients, all these complications occurred spontaneously, after several days of evolution, often coinciding with the aggravation of pulmonary lesions, but in the absence of invasive mechanical ventilation or non-invasive positive pressure ventilation.…”

Section: Discussionmentioning

confidence: 59%

“…Several articles, published in the medical literature worldwide [ 1 , 2 , 3 , 4 ], debate sporadic cases of spontaneous pneumomediastinum (PM), pneumothorax (PT), pneumopericardium (PP), and subcutaneous emphysema (SE) diagnosed in patients with SARS-CoV2 pneumonia, even in the absence of mechanical ventilation associated with barotrauma. Subsequently, several retrospective studies [ 4 , 5 ], the largest one being a multicenter analysis of Martinelli et al [ 3 ], focused on this topic. The principal pathophysiologic mechanism of PM is represented by the Macklin phenomenon, explaining the development of an increased pressure gradient between the marginal alveoli and the lung parenchyma, which, in the presence of the extensive alveolar injury, determines air leakage along the surrounding bronchovascular sheaths into the mediastinum.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Cuț

Tudoran

Lăzureanu

et al. 2021

JCM

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(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Cuț

Tudoran

Lăzureanu

et al. 2021

JCM

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“…Pneumopericardium is the presence of gas in pericardial space, which can be caused by trauma, positive pressure ventilation, unknown causes, therapeutic procedures [ 5 ], and recently recorded, COVID-19 pneumonia [ 6 ]. In large retrospective reviews of urological laparoscopy, pneumopericardium rarely occurred, moreover, all of the cases were incidentally detected without any symptoms [ 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Symptomatic pneumopericardium – A rare complication following retroperitoneal laparoscopic nephrectomy: A case report

Ngo

Bui

et al. 2021

International Journal of Surgery Case Reports

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“…According to Caceres et al, pneumomediastinum can develop without a triggering event and with no notable findings on chest radiography [ 12 ]. In the setting of COVID-19, there have been some reported cases of worsened patient outcomes when pneumomediastinum was present [ 6 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Spontaneous Pneumothorax and Pneumopericardium: A Case Report

Bistre¹,

Douedi²,

Alshami³

et al. 2021

Cureus

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Novel coronavirus 2019 (COVID-19) has been one of the largest and most devastating global pandemics of our time. There have been several complications of this disease that have also proven to be debilitating and deadly. While primarily affecting the respiratory system, some cases presented with uncommon complications such as pneumopericardium and spontaneous pneumothorax. We present a case of an elderly female diagnosed with COVID-19 found to have both spontaneous pneumothorax and pneumopericardium. She had a complicated hospital course and ultimately succumbed to her illness. While the pathogenesis of these conditions is not yet fully understood, further studies are needed to help clinicians develop treatment and prevention strategies to improve patient outcomes.

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Spontaneous Pneumopericardium and Pneumomediastinum in Twelve COVID-19 Patients

Cited by 34 publications

References 14 publications

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Symptomatic pneumopericardium – A rare complication following retroperitoneal laparoscopic nephrectomy: A case report

COVID-19 Associated Spontaneous Pneumothorax and Pneumopericardium: A Case Report

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